We need more GPs – and new ways of working as they can’t do it all

http://www.theguardian.com/society/2015/jun/09/we-need-more-gps-new-ways-working

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It makes sense at a time when we are struggling to increase GP numbers to look at more innovative models of care, especially for patients with complex health needs.

For example, we decided to employ our own senior nurse practitioners who have the flexibility and experience to work both in surgery and community settings. They can see and treat patients for many common illnesses, as well as offering advice on social care and nursing issues – which a GP may not always be able to do.

Related: ‘GP recruitment is what keeps me awake at night’ | Denis Campbell

The Department of Health hopes to increase the number of GP trainees in England to 3,250 per year but in the last four years this has remained stubbornly low at around 2,700, and although Health Education England (HEE) has introduced more GP training places, many remain unfilled. A recent survey in the British Medical Journal (BMJ) looked at factors deterring medical trainees from going into general practice.

Trainees cited primary care as lacking specialism, excitement and challenge and having more onerous managerial duties compared with hospital specialties. Conversely, those who chose general practice felt that it offered exposure to a broad spectrum of conditions, continuity of care and a better work-life balance.

HEE, working with the Royal College of GPs and BMA, is introducing an extra non-compulsory GP training year, to learn a specialism or gain experience abroad. They are also considering reducing training places for hospital specialties – for which supply outstrips demand. This would make sense as more and more work is being passed from secondary to primary care, without the equivalent shift in resources. It costs the taxpayer less than half as much to train a GP than a hospital consultant (three years of GP training versus eight years for a consultant).

But it’s not just recruitment of GPs that is a major headache. The rate of GPs entering the profession falls well short of the rate leaving or reducing their hours. Of GPs in training 65% are women, and 40% of women who leave the profession every year are under the age of 40. This is a worrying statistic. Historically it has been difficult for women to come back to general practice after extended periods of leave to have a family. “Retainer” and “returner” schemes are now being offered as part of the GP expansion strategy. But more GPs – men as well as women – are opting to work part-time now to maintain their work-life balance in the face of increased workloads. The last official, independent survey of GPs’ workload was conducted in 2007 and we urgently need a new one. In addition to their clinical work, GP partners are increasingly spending time in meetings and dealing with management. GP practices have become larger, conglomerate organisations and there are demands from NHS England, regulators and commissioners.

Patient needs are also changing, with more chronic disease being managed in primary care. There are also the worried well or working patients with busy lifestyles, who attend infrequently but come with many problems. Most of us have a 10- to 15-minute consultation frame. But these are arbitrary numbers. Unless a patient has a very minor complaint, it usually takes this allotted time just to take a history of the complaint, and much longer if they attend with a few problems. No one likes to feel that they are being rushed, especially when they have waited two weeks to see a GP. Like many practices, we operate some telephone triage so that the most appropriate staff see a patient. A patient needing a “pill check” would ideally see our nurse, a “minor illness” could go to our nurse practitioner and a “medication review” to our practice pharmacist. Traditionally these straightforward appointments would have been with GPs. It frees up our time to see the more difficult cases, such as a patient with uncontrolled epilepsy and neglect, who needs a falls assessment, referral to the epilepsy clinic and social services, who requires a longer, more demanding consultation.

There are no quick fixes when it comes to attracting and retaining GPs. Depicting general practice in a positive light would help. It does offer continuity, job satisfaction, and the chance for GPs to find their own niche. or specialismBut this is only achievable if we tackle the real problem of why GPs leave the profession, and recognise that there are other models of primary care rather than a GP who sees and treats all.